Conjunctivitis by Muhammad ibrahim

THE EYES ARE THE WINDOW OF THE SOUL

1

THE EYES ARE USELESS WHEN THE MIND IS BLIND

CONJUNCTIVITIS

Muhammad Ibrahim

MPH 2nd Semester

2

LEARNING OUTCOMES

3

After attending this presentation, the audience will be

able to:

Differentiate different types of conjunctivitis

Interpret signs and symptoms of different types of

conjunctivitis

Devise management of different types of

conjunctivitis

Design prevention plan for conjunctivitis

THE CONJUNCTIVA

Palpebral or tarsal

conjunctiva

Bulbar or ocular

conjunctiva

Fornix conjunctiva

4

Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap2, page 17, London, RE&PP Ltd.

CONJUNCTIVITIS

5

Irritation

Itching

Watering and

discharge

Redness

Discomfort

Pain and photophobia

in keratoconjunctivitis

Vasodilatation

Increased secretions

Edema

Follicles

Papillae

Keratinization

Membrane formation

Scarring (fibrosis)

Typical symptoms Typical signs

Infection or inflammation of the conjunctiva

More common in hot climates


BACTERIAL CONJUNCTIVITIS

6

The bacteria may invade

a normal, healthy

conjunctiva to produce a

primary bacterial

conjunctivitis

The bacteria may invade

because the conjunctival

defense against

infection is weakened,

called secondary

bacterial conjunctivitis


BACTERIAL CONJUNCTIVITIS

7

SIGNS AND SYMPTOMS

Key characteristic, mucopurulent discharge

In severe cases it is like yellow pus

In mild cases the eyelids may be stuck together on waking

There is always vasodilatation of conjunctiva

In severe cases there may be chemosis of the conjunctiva, edema of eyelids and general malaise

COMMON CAUSATIVE AGENTS

Staphylococcus cause acute primary conjunctivitis

Haemophilus influenza cause seasonal conjunctivitis

Gonococcus comes form genital discharges and cause severe conjunctivitis

Moraxella lacunata causes mild angular conjunctivitis

Other bacteria, pneumococcus, meningococcus, streptococcus etc.


TRACHOMA

8

Trachoma ( Ancient Greek “ Rough eye”)

Leading infectious cause of blindness world wide

WHO estimates 2.2 million people visually impaired world wide due to trachoma

Caused by one of the chlamydia group organism the “ chlamydia trachomatis”

WHO.Trachoma fact sheet N*382,March 2014

9

Symptoms Mild itching and irritation of the

eye

Watering

Mucopurrulent discharge from the eye

As the disease progresses, later trachoma symptoms include:

Marked light sensitivity (photophobia)

Blurred vision

Eye pain

SignsConjunctiva:

Follicular conjunctivitis (tarsal conj, fornices)

Limbal follicles

Conjunctival scarring

Herbert's pits (after resolution of follicles)

TRACHOMA


CONT.…

10

Cornea:

Keratitis (corneal ulcer)

Corneal opacity (end

stage)

Lids:

Entropion

Trichiasis


TRANSMISSION

11

TRACHOMA

Treatment

Tetracycline, topical (2 months) and oral (3 weeks)

Oral azithromycin

SAFE Strategy

Surgery for correction of trichiasis

Antibiotics

Face cleaning

Environmental improvement

12

WHO.Trachoma fact sheet N*382,March 2014 (GET 2020)

VIRAL CONJUNCTIVITIS

13

Viruses live in the epithelial cells and often invade the epithelial cells of the cornea

Viruses live inside the body cells so they are all immune to antibiotics

Disease may be so mild that it is impossible to recognize it clinically

It may be a severe and disabling condition

TYPICAL SIGN AND SYMPTOMS

Gritty foreign body sensation and photophobia

Watery and not purulent secretions called serous secretion

Blood vessels are dilated and there is hypertrophy of the lymphoid follicles

There may be papillary hypertrophy on the upper tarsal conjunctiva


ADENOVIRUS CONJUNCTIVITIS

Most common viral infection of the conjunctiva

There are many different strains of the virus, all the

strains are very contagious

Usually bilateral but often affects one eye more

severely than other

Superficial punctate keratitis and psuedomembrane

are specific signs

The infection is easily spreads from person to

person by direct contact specially in workers

examining eyes 14




MEASLES

Generalized viral infection

Also invades the conjunctival and corneal epithelium

It can cause serious corneal ulceration and blindness

MOLLUSCUM CONTAGIOSUM

Viral wart which appears on the margins of the eyelids

Virus particles are discharged from the wart into the

conjunctiva and cause a typical follicular conjunctivitis

Treatment is to remove the wart

either by excision, cautery or curettage

15



16

HERPES SIMPLEX VIRUS Wide spread virus

Cause follicular conjunctivitis, corneal ulcer, multiple vesicles on the face, mouth, or eyelids

Spread by direct contact

The virus remain dormant until years and cause recurrent infections

Anti viral treatment

Debridement and chemical cauterization techniques are used for corneal epithelial removal


GRANULOMATOUS CONJUNCTIVITIS

Also called parinaud’s syndrome

Unilateral with a local inflammatory granuloma in

the conjunctiva

Usually means the conjunctiva has become by

chance the route of entry into the body for some

micro organism

Possible causes:

Tuberculosis

Syphilis

Actinomycosis ( fungal disease)

Sporotrichosis ( fungal disease)17


ALLERGIC CONJUCTIVITIS

It can occur in four forms

A. Vernal conjunctivitis

Originally called spring catarrh

May occur through out the year

Common in children

Not caused by specific allergen

Most likely agent is some material in the

atmosphere such as pollen

Belong to same group of diseases as allergic

rhinitis, asthma and eczema atopic diseases18



19

SYMPTOMS AND SIGNS

Severe and persistent itching and irritation in both eyes

Feeling string or worms in the eyes

Sticky white discharge

Thickening of conjunctiva with formation of papillae

Giant papillae in the advance stage, spaces between papillae filled with mucus

Cobblestone appearance

Superficial punctate keratitis

Shield ulcer

MANAGEMENT

Steroids

Antihistamine

Cryotheraphy

Diathermy and cautery

Beta radiation given with a strontium 90 applicator



B. Hay fever conjunctivitis Acute allergic reaction to pollen in the air

Usually associated with acute rhinitis

Non of the structural changes like in the vernal conjunctivitis

C. Phlyctenular conjunctivitis Phlycten is Greek word for a blister

Localized hypersensitivity reaction to bacterial

proteins in the bloodstream, mostly tubercular

Phlycten appears as a raised pinkish nodule

surrounded by an area of hyperemia

It then develops a necrotic grey center surrounded

by reactive inflammation

D. Allergies to drugs and cosmetics Medications , chemical preservatives, cosmetics can provoke an

allergic reaction

Diagnosed by taking careful history

Stop the provoking agent

Topical steroids will relieve the symptoms20


ENDOGENOUS CONJUNCTIVITIS

Cause of the inflammation may be an inflammation

arising from within the body itself

Exact mechanism is not known but in most cases it

is a type of auto immune disease

KERATOCONJUNCTIVITIS SICCA

Common specially in old people

Often associated with rheumatoid arthritis

The lacrimal gland and accessory conjunctival

glands become inflammed so produce fewer tears

The eyes are sore and gritty

Schirmer’s test 21


ENDOGENOUS CONJUNCTIVITIS

OCULAR PEMPHIGOID

Some times called essential shrinkage of the

conjunctiva

Gradual shrinkage and fibrosis of the conjunctiva

Symblepharon in advance cases

STEVEN-JOHNSON SYNDROME

Acute ulceration of the conjunctiva and other mucous

membranes like the mouth and vagina

Followed by severe scarring of the membranes

Often caused by sensitivity to drugs, particularly

sulphonamides

Topical and systemic steroids in acute stage may help22


NEONATAL CONJUCTIVITIS

( OPHTHALMIA NEONATORUM) Conjunctivitis in a newborn child

GONOCOCCUS is most serious cause

Baby may be infected during delivery if the

mother genital tract is infected

Cause acute conjunctivitis within the first few

days of birth

May cause corneal ulceration, scarring and

eventually blindness

CHLAMYDIA, Organism similar to trachoma

May be present in the female genital tract

Cause conjunctivitis within the first 2 weeks of

birth

STAPHYLOCOCCUS and other organism of a

non genital origin may also infect the infant

conjunctiva23


PREVENTION OF CONJUNCTIVITIS

24

If you have infectious conjunctivitis, you can help limit its spread to other people by following these steps:

Wash your hands often with soap and warm water

Avoid touching or rubbing your eyes

Wash any discharge from around the eyes several times a day

Wash hands after applying eye drops or ointment


Do not use the same eye drop dispenser/bottle for infected and non-infected eyes—even for the same person

Wash pillowcases, sheets, washcloths, and towels in hot water and detergent; hands should be washed after handling such items

Avoid sharing articles like towels, blankets, and pillowcases

Clean eyeglasses, being careful not to contaminate items (like towels) that might be shared by other people

Do not share eye makeup, face make-up, make-up brushes, contact lenses and containers, or eyeglasses

Do not use swimming pools25


26

If you are around someone with infectious conjunctivitis, you can reduce your risk of infection by following these steps:

Wash your hands often with soap and warm water

Wash your hands after contact with an infected person or items he or she uses

Do not share items used by an infected person; for example, do not share pillows, washcloths, towels, eye drops, eye or face makeup, and eyeglasses


27

If you have infectious conjunctivitis, there are steps you can take to avoid re-infectiononce the infection goes away:

Throw away and replace any eye or face makeup you used while infected

Throw away contact lens solutions that you used while your eyes were infected

Throw away disposable contact lenses and cases that were used while your eyes were infected

Clean extended wear lenses as directed

Clean eyeglasses and cases that were used while infected

28

Healthcare

Conjunctivitis by Muhammad ibrahim